Vasopressin improves vital organ blood flow after prolonged cardiac arrest with postcountershock pulseless electrical activity in pigs

Volker Wenzel, Karl H. Lindner, Andreas W. Prengel, Christopher Maier, Wolfgang Voelckel, Keith G. Lurie, Hans U. Strohmenger

Research output: Contribution to journalReview articlepeer-review

135 Scopus citations

Abstract

Objective: Although a benefit of vasopressin when compared with epinephrine was shown during cardiopulmonary resuscitation (CPR) after a short duration of ventricular fibrillation cardiac arrest, the effect of vasopressin during prolonged cardiac arrest with pulseless electrical activity is currently unknown. Design: Prospective, randomized laboratory investigation using an established porcine model with instrumentation for measurement of hemodynamic variables, vital organ blood flow, blood gases, and return of spontaneous circulation. Setting: University hospital laboratory. Subjects: Eighteen domestic pigs. Interventions: After 15 mins of cardiac arrest and 3 mins of chest compressions, 18 animals were randomly treated with either 0.8 units/kg vasopressin (n = 9) or 200 μg/kg epinephrine (n = 9). Measurements and Main Results: Compared with epinephrine, vasopressin resulted, at both 90 secs and 5 mins after drug administration, in significantly higher (p < .05) median (25th-75th percentiles) left ventricular myocardial blood flow (120 [range, 96193] vs. 54 [range, 11-92] and 56 [range, 41-80] vs. 21 [range, 1140] mL/min/100 g, respectively) and total cerebral blood flow (85 [78-102] vs. 24 [18-41] and 50 [44-52] vs. 8 [5-23] mL/min/100 g, respectively). Spontaneous circulation was restored in eight of nine animals in the vasopressin group and in one of nine animals in the epinephrine group (p= .003). Conclusions: Compared with a maximum dose of epinephrine, vasopressin significantly increased left ventricular myocardial and total cerebral blood flow during CPR and return of spontaneous circulation in a porcine model of prolonged cardiac arrest with postcountershock pulseless electrical activity.

Original languageEnglish (US)
Pages (from-to)486-492
Number of pages7
JournalCritical care medicine
Volume27
Issue number3
DOIs
StatePublished - 1999

Keywords

  • Blood flow
  • Cardiopulmonary resuscitation
  • Cerebrum
  • Epinephrine
  • Myocardium
  • Pulseless electrical activity
  • Return of spontaneous circulation
  • Vasopressin

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